长期禁食水可增加远端胃癌根治术后胃瘫的发生风险

目的:探讨围手术期长期禁食水与胃下部癌患者行远端胃癌根治术后发生胃瘫的相关性。方法:将76例确诊为胃癌的病人随机分成实验组及对照组，实验组术前不禁食水，术后在静脉营养支持治疗的同时第1天嘱患者少量多次饮水，第2~3天根据患者情况增加饮水量至500 ml，第4~5天经口行肠内营养等全流质饮食并根据患者情况逐步过渡到半流食。对照组术前1天禁食水，术后给予静脉营养及肠内营养支持，术后1周左右开始试行进食，并保证两组患者的术者、手术方式、营养支持、抗感染及抑酸等治疗方案一致。结果:实验组患者术后胃瘫发生例数（1例）明显少于对照组（6例），差异有统计学意义（P=0.047）。而两组患者在术后营养状态、感染及吻合口瘘等并发症方面发生率无显著差异（P>0.05）。结论:围手术期长期禁食水可以增加胃下部癌根治术后胃瘫发生风险，术后早期经口进食可以降低胃下部癌术后胃瘫发生几率，不增加感染及吻合口瘘等并发症发生率，安全有效。

Long term fasting can increase the risk of gastroparesis after radical gastrectomy for distal gastric cancer

Objective:To investigate the correlation between long term fasting during peri-operative period and gastroparesis after radical gastrectomy for distal gastric cancer.Methods:76 patients who diagnosed as gastric cancer were randomly divided into experimental group and control group.Experimental group:Preioperative period do not fasting water，parenteral nutrition support treatment was given postoperative，at the same time，the patients drank some water in the first day.During the 2~3 days according to the individual to increase the amount of water to 500 ml，during the 4~5 days，patients drank enteral nutrition and liquid diet through mouth and all patients gradual transition to the semi-liquid diet.Control group:Fasting from 1 day before operation until 1 week after operation.During this period，intravenous nutrition and enteral nutrition support treatment were given to the patients.Ensure that the two groups of patients' operator，operation mode，nutrition support，anti-infection and anti-acid therapy were consistent.Results:The number of cases of postoperative gastroparesis (1 case) in the experimental group was significantly less than that in the control group (6 cases)，the difference was statistically significant.There was no significant difference between the two groups in postoperative nutritional status，infection and anastomotic leakage.Conclusion:Perioperative long-term fasting can increase the risk of gastroparesis after radical gastrectomy for distal gastric cancer.Early postoperative oral feeding can reduce the risk and does not increase infection and anastomotic leakage and other complications，which is safe and effective.